Thirty-five percent the injuries were sprains or strains. Fractures accounted for 23 percent of injuries and soft tissue injuries were 22 percent. While concussions and other closed-head injuries accounted for only 7 percent of overall injuries, the rate of concussions increased by 1,596 percent over the last 25 years. In 1990, 1,589 head injuries were reported, but that number jumped to 22,750 by 2014 – or 62 a day. Older children and teens accounted for roughly two-thirds of injuries.

Dr. Huiyun Xiang, senior author and director of research core at Nationwide’s Center for Injury Research and Policy, said in a statement that soccer had changed dramatically in 25 years.

We’re seeing athletes play year-round now thanks to club, travel and rec leagues, and the intensity of play is higher than it ever has been,” he says.

Tracy Mehan, study co-author and manager of translational research at Nationwide’s Center for Injury Research and Policy, says the amount of time children spend on the soccer field has increased.

“It’s much more intense and we’re not giving kid’s bodies a break in between seasons,” she says. “They are just playing a lot more than they used to. There is an increase in exposure time. We can’t say it’s a direct correlation, but kids are playing more and we’re seeing more injuries.”

Data for the study were obtained from the National Electronic Injury Surveillance System, which is operated by the U.S. Consumer Product Safety Commission. The data only includes injuries treated in emergency rooms, which makes it difficult to assess the scope of the problem.

This is just the tip of the iceberg,” Mehan says. “We know that a lot of kids don’t always go to the ER. They go to the athletic director or their primary care provider.”

Instead, they made recommendations about how to avoid injuries, including proper warm-ups, encouraging children to follow the rules, wearing safety gear and not allowing young players to head the ball.